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Updated: Mar 19, 2026

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A conundrum: general or neuraxial anesthesia and the use of ROTEM
A A Mauritz1, Z Y Strouch1, A J Olufolabi1
1Department of Anesthesiology, Duke University Medical Center, Box 3094, Mail Sort #10, Durham, NC 27710, USA.
Abstract:
We report the use of rotational thromboelastometry (ROTEM) to guide the management of a 29-year-old primigravida at 36weeks' gestation with portal hypertension, esophageal varices, suspected pseudocholinesterase deficiency, and steroid refractory thrombocytopenia presenting to labor and delivery with worsening peripheral edema and new-onset hypertension. A multidisciplinary decision for preoperative platelet transfusion and cesarean delivery under spinal anesthesia was made, guided by ROTEM. A successful cesarean delivery was performed with no bleeding complications.
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